Free Consent Form Template
Patients or participants complete your intake form before they arrive, and a filled consent PDF lands in your records folder.
| Patient | {{Patient Name}} |
| Date of birth | {{Date of Birth}} |
| Reason for visit | {{Reason for Visit}} |
| Parent / guardian | {{Guardian Name}} |
| Consent given | {{Consent}} |
See this template in action
A parent completes a clinic intake form on her phone; AutoDoc files the consent PDF and adds a guardian form because the patient is under 18.
Watch on YouTube →What’s in this template
A treatment consent record with the patient’s details, the reason for the visit, a consent statement and signature lines, plus a reference number. It pairs naturally with a guardian consent version for minors.
Make it yours
- Replace the consent wording with text approved by your professional body.
- Add specific risks for the treatments you offer.
- Duplicate it as a guardian version and attach it with an Age Group condition.
How to use this template
Download and open in Google Docs
Upload the .docx to Google Drive, open it with Google Docs and choose File → Save as Google Docs. Swap “YOUR COMPANY” for your details and add your logo.
Copy the ready-made Google Form
Make a copy of the ready-made form. Its question titles already match the placeholders. Or build it yourself:
| Question title | Type | Example answer |
|---|---|---|
| Patient Name | Short answer | Ethan Lim |
| Date of Birth | Date | 2011-04-18 |
| Reason for Visit | Paragraph | Ankle sprain from football |
| Age Group | Multiple choice | Under 18 |
| Guardian Name | Short answer | Grace Lim |
| Consent | Checkboxes | I consent to assessment and treatment. |
Placeholders in this template
Built-ins (starting with _) are filled automatically: date, time, response ID.
Generate it on every submission
Install AutoDoc, pick this file as your template and a Drive folder, and each response creates a finished Treatment Consent Form automatically, emailed if you like.
Install AutoDoc freePro tips
- Add a guardian consent template with the condition Age Group equals “Under 18”.
- Leave “Share generated output files” off so records stay private to your Drive.
- Use {{_responseId}} as a reference number on every page footer.
Frequently asked questions
Is the Treatment Consent Form template really free?
Yes. Download the .docx file, upload it to Google Drive and open it with Google Docs. You can use it with or without AutoDoc.
How do I use it in Google Docs?
Upload the file to Drive, open it with Google Docs, then File → Save as Google Docs. Replace YOUR COMPANY text and keep the {{placeholders}}.
Do the placeholders need to match my form?
Yes. Each {{placeholder}} must match a question title exactly (case-sensitive). The question list on this page matches the template.